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r 7i <br /> HEALTH AND SAFETY EVALUATION <br /> r <br /> Hazard Assessment <br /> '�✓ Background Review: Com lete <br /> P ❑Partial If partial why? <br /> r <br /> Activities Covered Under This Plan: <br /> ..� No. Task/Subtask <br /> Description Schedule <br /> lleC+ 500 ccnCV jToi�rrar- j c�< <br /> J• <br /> Types of Hazards: <br /> ❑Numbers refer 10 One Of the followm9 hazard evaluation forms. cor,Dlele hazard evaluation forms for each r aDDrODnate haZarQ c18ss. <br /> Physiochemical El Chemically Toxic Radiation <br /> ,_.,/ Biological <br /> ❑Flammable `3/Inhalation!J Carcinogen Ionizing: <br /> ❑Etiological Agent <br /> Ingestion ❑Mutagen ❑Other PI <br /> ❑Internal exposure (Plant,insect,animal) <br /> ❑Explosive ❑Contact 11 Teratogen <br /> VAbsorbtion ❑OSHA 1910.1000 ❑External exposure <br /> ❑Corrosive Substance <br /> ❑Reactive <br /> Non-ionizing: <br /> 02 Rich ❑OSHA Specific Hazard Sub. Standard �-�/ <br /> .. Describe. ❑W ❑IR LJ Physical Hazards <br /> ❑OZ Deficient <br /> ❑RF ❑MicroW ❑Construction Activities <br /> ❑laser <br /> Source/Location of Contaminants and Hazardous Substances <br /> r Directly Related to Tasks Indirectly Related to Tasks•Nearby Process(es) That Could Affect Team <br /> L'J <br /> ,B/ Members: <br /> Air <br /> r❑yOther Surface ❑Client Facility <br /> 12"Groundwater ❑Nearby Non-client Facility <br /> Soil <br /> ❑Surface Water <br /> Describe: <br /> ❑Other <br /> r <br /> ❑Client Briefing Arranged <br /> r <br />